Surgical anatomy of the pectoral nerves and the pectoral musculature
Article first published online: 28 NOV 2011
Copyright © 2011 Wiley Periodicals, Inc.
Volume 25, Issue 5, pages 559–575, July 2012
How to Cite
Porzionato, A., Macchi, V., Stecco, C., Loukas, M., Tubbs, R. S. and De Caro, R. (2012), Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin. Anat., 25: 559–575. doi: 10.1002/ca.21301
- Issue published online: 1 JUN 2012
- Article first published online: 28 NOV 2011
- Manuscript Accepted: 16 OCT 2011
- Manuscript Revised: 24 AUG 2011
- Manuscript Received: 11 OCT 2010
- pectoral muscles;
- anatomical variation;
- iatrogenic injury
The pectoral nerves (PNs) may be selectively injured through various traumatic mechanisms such as direct trauma, hypertrophic muscle compression, and iatrogenic injuries (breast surgery and axillary node dissection, pectoralis major muscle transfers). The PN may be surgically recovered through nerve transfers. They may also be used as donors to the musculocutaneous, axillary, long thoracic, and spinal accessory nerves and for reinnervation of myocutaneous free flaps. Thus, in this article, we reviewed the surgical anatomy of PN. A meta-analysis of the available literature showed that the lateral pectoral nerve (LPN) arises most frequently with two branches from the anterior divisions of the upper and middle trunks (33.8%) or as a single root from the lateral cord (23.4%). The medial pectoral nerve (MPN) usually arises from the medial cord (49.3%), anterior division of the lower trunk (43.8%), or lower trunk (4.7%). The two PN are usually connected immediately distal to the thoracoacromial artery by the so-called ansa pectoralis. The MPN may also show communications with the intercostobrachial nerve. In 50%–100% of cases, it may pass, at least with some branches, through the pectoralis minor muscle. The LPN supplies the upper portions of the pectoralis major muscle; the MPN innervates the lower parts of the pectoralis major and the pectoralis minor muscle. Among the accessory muscles of the pectoral girdle, the LPN may also innervate the tensor semivaginae articulationis humero-scapularis, pectoralis minimus, sternoclavicularis, axillary arch, sternalis, and infraclavicularis muscles; the MPN may innervate the pectoralis quartus, chondrofascialis, axillary arch, chondroepitrochlearis, and sternalis muscles. Clin. Anat. 25:559–575, 2012. © 2011 Wiley Periodicals, Inc.